Request to Surrender

Due to limited availability and distribution of foster homes, UYR can only accept owner surrenders from these states: California, Connecticut, Florida, Georgia, Iowa, Illinois, Indiana, Michigan, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Wisconsin. If you are not located in one of these states, we suggest you check Petfinder.com for other breed specific rescue groups in your area. You may also wish to ask your local humane society if they work with breed specific rescues or small dog rescues. Vets and groomers are also good sources for rescue information.

If you are located in one of the UYR supported states, you should continue with this online surrender request. Surrendering your dog is an irrevocable decision; once surrendered, you release your rights as a pet owner. UYR does not return or readopt dogs to the surrendering owner.

NOTE: All "Required Field" errors refer to the entry block above the warning.

This form must be completed in its entirety before we can consider accepting your dog into UYR. Every field must have a response. Indicate NA if you don't know the answer. Once we receive this request, we'll determine if we have an appropriate home available to accommodate your dog's needs. A UYR representative will contact you regarding your surrender.

Your Name:

Street Address:

City:

State:

Zip Code:

Telephone Number:

Alternate Phone Number:

Email Address:

Dog Name:

Dog Age:

Date of Birth:

Gender:

Weight:

Photo of Dog:

Delete?

Breed:

Reason for surrender:

Any health issues:

Care currently given for these issues:

Last Vet Visit:

Vet Name and Number:

Vet Fax Number:

May we contact your vet:

Up to date on shots:

Rabies Vaccination:

Rabies Date Done:

Parvo/Distemper:

Parvo/Distemper Date Done:

Bordetella Vaccination:

Bordetella Date Done:

Heartworm Test Done:

HW Date Done:

HW Prevention Used:

Fecal Test Done:

Spayed/Neutered:

Is there anything else we should know about this dog:

Gets along with children:

Gets along with other dogs:

Gets along with cats:

Has dog ever bitten:

Explain bite situation:

Is dog housetrained:

If no, please explain:

UYR is dependent on donations to give the needed care to our rescues.

Are you willing to make a donation to help with these costs:

If so, how much:

$

How did you hear about UYR:

Have you contacted other groups, if so explain:

May we refer your request to another reputable group if we have no one to help you: